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Introductory Anatomy of Digestive System

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Introductory Anatomy of Digestive System NYUNDO Martin, MD, MMed (Surgeon) Lecturer Dpt of Surgery and Dpt of Clinical Anatomy FACMED-NUR – PowerPoint PPT presentation

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Title: Introductory Anatomy of Digestive System


1
Introductory Anatomy of Digestive System
  • NYUNDO Martin, MD, MMed (Surgeon)
  • Lecturer
  • Dpt of Surgery and Dpt of Clinical Anatomy
  • FACMED-NUR

2
General considerations
  • Digestive system is a series of hollow organs
    joined in a long, twisting tube from the mouth to
    the anus and other organs that help the body
    break down and absorb food
  • ?The main organs are Mouth and pharynx,
    Oesophagus Stomach, Small and Large
    intestines,Appendix and Anus
  • ? Accessory organs Salivary glands, Liver,
    Gallbladder, Pancreas

3
General considerations contd
  • The gastrointestinal tract has a uniform general
    histology.The GI tract can be divided into 4
    concentric layers
  • Mucosa is the innermost layer this layer comes
    in direct contact with the food (or bolus), and
    is responsible for absorption and secretion,
    important processes in digestion.
  • Submucosa
  • Muscularis externa (the external muscle layer)
  • Adventitia or serosa

4
  • Accessory organs
  • The liver secretes bile into the small intestine
    via the bile duct, employing the gallbladder as a
    reservoir. Apart from storing and concentrating
    bile, the gallbladder has no other specific
    function.
  • The pancreas secretes an isosmotic fluid
    containing bicarbonate, which helps neutralize
    the acidic chyme, and several enzymes into the
    small intestine. Both of these secretory organs
    aid in digestion

5
General considerations contd
  • Abdomen
  • The abdomen is the part of the trunk between the
    thorax and the pelvis
  • It is a flexible, dynamic container, housing most
    of the organs of the digestive system and part of
    the urogenital system.
  • Containment of the abdominal organs and their
    contents is provided by
  • musculoaponeurotic walls anterolaterally,
  • diaphragm superiorly,
  • muscles of the pelvis inferiorly,
  • lumbar vertebral column in the posterior.

6
  • The abdomen encloses and protects its contents
    while allowing the flexibility between the more
    rigid thorax and pelvis required by respiration,
    posture, and locomotion.
  • Through voluntary or reflexive contraction, its
    muscular roof, anterolateral walls, and floor can
    raise internal (intra-abdominal) pressure to aid
    expulsion from the abdominopelvic cavity or from
    the adjacent thoracic cavity, expulsion of air
    from the thoracic cavity (lungs and bronchi) or
    of fluid (e.g., urine or vomitus), flatus, feces
    from the abdominopelvic cavity.

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General considerations contd
  • Peritoneum and Peritoneal Cavity
  • The peritoneum is a continuous, glistening and
    slippery transparent serous membrane. It lines
    the abdominopelvic cavity and invests the
    viscera.
  • The peritoneum consists of two continuous layers
    the parietal peritoneum, which lines the internal
    surface of the abdominopelvic wall, and the
    visceral peritoneum, which invests viscera such
    as the stomach and intestines.

9
  • The peritoneal cavity is a potential space of
    capillary thinness between the parietal and
    visceral layers of peritoneum.
  • It contains no organs but contains a thin film of
    peritoneal fluid, which is composed of water,
    electrolytes, and other substances derived from
    interstitial fluid in adjacent tissues.
  • Peritoneal fluid lubricates the peritoneal
    surfaces, enabling the viscera to move over each
    other without friction and allowing the movements
    of digestion.

10
  • In addition to lubricating the surfaces of the
    viscera, the peritoneal fluid contains leukocytes
    and antibodies that resist infection.
  • Lymphatic vessels absorb the peritoneal fluid.
  • The peritoneal cavity is completely closed in
    males however, there is a communication pathway
    in females to the exterior of the body through
    the uterine tubes, uterine cavity, and vagina.
    This communication constitutes a potential
    pathway of infection from the exterior.

11
General considerations contd
  • Diaphragm
  • The diaphragm is a double-domed musculotendinous
    partition separating the thoracic and abdominal
    cavities.
  • Its mainly convex superior surface faces the
    thoracic cavity, and its concave inferior surface
    faces the abdominal cavity.

12
  • The diaphragm is the chief muscle of inspiration.
  • It descends during inspiration however, only its
    central part moves because its periphery, as the
    fixed origin of the muscle, attaches to the
    inferior margin of the thoracic cage and the
    superior lumbar vertebrae.
  • Orifices vena caval foramen, esophageal hiatus
    and aortic hiatus.

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Esophagus
  • First part of the digestive tract, that conveys
    food from the pharynx to the stomach it is
    about 25 cm long and 2 cm of diameter.
  • Is divided into three anatomical parts
  • cervical (superior), thoracic (middle) and
    abdominal (inferior).
  • The esophagus
  • Follows the curve of the vertebral column as it
    descends through the neck and mediastinum in the
    median partition of the thoracic cavity.
  • Has internal circular and external longitudinal
    layers of muscle.

16
  • In its superior third, the external layer
    consists of voluntary striated muscle the
    inferior third is composed of smooth muscle, and
    the middle third is made up of both types of
    muscle.
  • Passes through the esophageal hiatus in the
    diaphragm,
  • Terminates by entering the stomach at the cardial
    orifice of the stomach

17
Esophagus contd
  • The esophagus has 2 sphincters
  • A sphincter is a narrowing caused by contracted
    (tightened) muscles.
  • These muscles remain contracted until the body
    sends a message for the muscles to relax. When
    the muscles of the sphincter relax, this then
    allows things to pass.
  • One sphincter is at the top of the esophagus. The
    other is where the esophagus meets the stomach
    this is known as the gastro-esophageal junction.

18
  • The lower sphincter controls the movement of food
    into the stomach and prevents stomach acid from
    going up into the esophagus (gastro-esophageal
    reflux).
  • The lining of the esophagus is very different to
    that of the stomach and stomach acid will cause
    it to become inflamed and sore if reflux does
    occur.

19
Stomach
  • The stomach is the expanded part of the
    alimentary tract between the esophagus and the
    small intestine.
  • It is specialized for the accumulation of
    ingested food, which it chemically and
    mechanically prepares for digestion and passage
    into the duodenum.

20
  • RESERVOIR
  • 2-3L food in adult
  • 30ml in newborn
  • SHAPE VARIES
  • Individual build
  • Respiration
  • Contents
  • Position assumed by individual

21
Stomach contd
  • Parts of the Stomach
  • CARDIA
  • the part surrounding the cardial orifice.
  • Orifice at 7th costal cartilage L
  • 2-4 cm from median at T10 or T11 level
  • FUNDUS - the dilated superior part limited
    inferiorly by the horizontal plane of the cardial
    orifice.
  • BODY - the major part of the stomach between the
    fundus and the pyloric antrum
  • PYLORUS (Pyloric part)
  • From notch - pyloric sphincter
  • At L1-L3 R median plane

22
Stomach contd
  • The stomach has two curvatures
  • Lesser curvature forms the shorter concave
    border of the stomach
  • Greater curvature forms the longer convex border
    of the stomach
  • Two surfaces
  • Anterior
  • Posterior

23
Stomach contd
  • Relations
  • FUNDUS diaphragm
  • ANT SURFACE - diaphragm, liver L lobe ant abd
    wall
  • POST SURFACE - omental bursa retroperitoneal
    structures (kidney, pancreas, spleen.)
  • SUPERIOR - lesser omentum gastric vessels.
  • INFERIOR - greater omentum gastro-epiploic
    vessels.

24
Stomach contd
  • Principles of blood supply
  • 2 MAJOR ART SOURCES
  • Coeliac trunk
  • Superior mesenteric
  • VENOUS DRAINAGE
  • Follow arteries
  • LYMPHATIC DRAINAGE
  • Follow arteries

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Stomach contd
  • Venous drainage
  • FOLLOW ARTS
  • Drain into portal systems
  • R L ? portal vein
  • R GASTROEPIPLOIC (G-MENTAL) V ? superior
    mesenteric ? may enter portal v direct or join
    splenic v
  • L GASTROEPIPLOIC (G-MENTAL) ? splenic vein and
    its tributariess short gastric vs.

27
Venous drainage
28
Lymphatic drainage
  • ALL LYMPH PASSES TO COELIAC GP of pre-aortic
    nodes
  • ALL LYMPH VS. ACCOMPANY ARTS along the 2 curves
  • 4 MAJOR AREAS OF DRAINAGE
  • LESSER CURV
  • Largest drains to L gastric LNs
  • R PART GREATER CURV
  • Drains gastroepiploic pyloric LNs
  • L PART GREATER CURV
  • Drains pyl, gastoepip, pancreticosplenic LNs
  • LESSER CURVE RELATED TO PYL
  • Drains to R gastric LNs

29
Lymphatics
30
  • Common lymphatics pathway
  • Drain to coeliac LN ? Coeliac trunk ?cisterna
    chyli ? Thoracic duct

31
Nerve supply
  • PARASYMPATHETIC from ant and post vagal trunks
  • SYMPATHETIC from coeliac plexus
  • EFFERENT FIBRES from segments T6-T10
  • VAGAL TRUNKS
  • Ant ? lesser curve? hepatic duodenal branch
  • Post ? lesser curve from post surface ? coeliac ?
    coeliac plexus ? post gastric branch

32
Nerve supply
33
3. SMALL INTESTINES
  • Extent stomach to colon
  • Length approximately 5m
  • Parts
  • Duodenum
  • Jejunum
  • Ileum

34
DUODENUM
  • The duodenum, the first and shortest (25 cm) part
    of the small intestine, is also the widest and
    most fixed part.
  • The duodenum pursues a C-shaped course around the
    head of the pancreas.
  • The duodenum begins at the pylorus on the right
    side and ends at the duodenojejunal junction on
    the left side. ( Treitz ligament)
  • The junction usually takes the form of an acute
    angle, the duodenojejunal flexure.
  • Most of the duodenum is fixed by peritoneum to
    structures on the posterior abdominal wall and is
    considered partially retroperitoneal.

35
  • The duodenum is divisible into four parts
  • Superior (first) part short (approximately 5 cm)
    and lies anterolateral to the body of the L1
    vertebra.
  • Descending (second) part longer (7-10 cm) and
    descends along the right sides of the L1-L3
    vertebrae.
  • Horizontal (third) part 6-8 cm long and crosses
    the L3 vertebra.
  • Ascending (fourth) part short (5 cm) and begins
    at the left of the L3 vertebra and rises
    superiorly as far as the superior border of the
    L2 vertebra.

36

Superior or First Part
1
2
4
3
Descending or Second Part
Horizontal or Third Part
Fourth or Ascending Part
37
Duodenum blood supply
  • The arteries arise from the celiac trunk and the
    superior mesenteric artery. The celiac trunk, via
    the gastroduodenal artery and its branch,
  • The veins follow the arteries and drain into the
    portal vein, some directly and others indirectly,
    through the superior mesenteric and splenic
    veins.
  • The lymphatic vessels of the duodenum follow the
    arteries.

38
CLINICALCORRELATES
  • Duodenal ulcer
  • Usual located sup aspect - 1st part
  • When post, penetration may cause bleeding
    (gastroduodenal art) or erosion into head of
    pancreas
  • Ant ulcers may perforate into peritoneum
    (peritonitis).

39
JEJUNUM ILEUM
  • Jejunum 2nd part of the small intestine, begins
    at the duodenojejunal flexure at the Treitz
    ligament where the alimentary tract resumes an
    intraperitoneal course.
  • Wider, thicker-walled than ileum
  • Mucous membrane thrown into circular folds with
    many longer villi
  • Ileum third part of the small intestine, ends at
    the ileocecal junction, the union of the terminal
    ileum and the cecum .
  • Together, the jejunum and ileum are 6 to 7 m
    long, the jejunum constituting approximately two
    fifths and the ileum approximately three fifths
    of the intraperitoneal section of the small
    intestine.

40
Jejunum and ileum
  • Although no clear line of demarcation between the
    jejunum and ileum exists, they have distinctive
    characteristics that are surgically important
  • The jejunum and ileum can be distinguished by
    ther color, feel and their complexity of arterial
    arcades
  • ? Jejum redder wall, thicker wall(feels
    full) and simple arcades
  • ? Ileum thinner wall, (feels empty),
    multiple arcades

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  • The mesentery is a fan-shaped fold of peritoneum
    that attaches the jejunum and ileum to the
    posterior abdominal wall
  • The superior mesenteric artery supplies the
    jejunum and ileum .
  • The superior mesenteric vein drains the jejunum
    and ileum.
  • Specialized lymphatic vessels in the intestinal
    villi
  • Blood vs. arrangement varies jej ileum

43
MESENTERIC LYMPH NODES
44
Large Intestine
  • The large intestine is the site where water is
    absorbed from the indigestible residues of the
    liquid chyme, converting it into semisolid stool
    or feces that is stored temporarily and allowed
    to accumulate until defecation occurs.
  • Extent
  • Ileocaecal junction to anus about 1.5 m long
  • Parts
  • Caecum vermiform appendix
  • Ascending, transverse descending
  • Sigmoid
  • Rectum anal canal

45
Small large intestines
46
Large Intestine contd
  • The large intestine can be distinguished from the
    small intestine by
  • Omental appendices small, fatty, omentum-like
    projections.
  • Three teniae coli
  • (1) mesocolic, to which the transverse and
    sigmoid mesocolons attach
  • (2) omental, to which the omental appendices
    attach and
  • (3) free (L. libera), to which neither mesocolons
    nor omental appendices are attached.
  • Haustra sacculations of the wall of the colon
    between the teniae
  • A much greater caliber (internal diameter).
  • Mucosa
  • No villi, numerous mucus cells

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Caecum
  • Blind sac invested in peritoneum
  • 8 cm W x 8 cm L, located in RIF
  • Vermiform appendix
  • Attached to posteromedial wall
  • Taenia coli converge on appendix
  • Ileocaecal orifice
  • Opens on medial wall
  • Surrounded by ileocaecal sphincter

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Caecum vermiform appendix
51
Vermiform appendix
  • About 8 cm long
  • Arises posteromedial aspect of caecum
  • About 3 cm below ileocaecal orifice
  • Mesoappendix
  • Connects perit. to ileum
  • Appendicular art within this fold
  • Commonly behind caecum or in pelvis
  • Very mobile its relations are variable

52
Position of the Appendix
  • A retrocecal appendix extends superiorly toward
    the right colic flexure and is usually free.
  • The appendix may project inferiorly toward or
    across the pelvic brim.
  • The anatomical position of the appendix
    determines the symptoms and the site of muscular
    spasm and tenderness when the appendix is
    inflamed.
  • The base of the appendix lies deep to a point
    that is one third of the way along the oblique
    line joining the right ASIS to the umbilicus (the
    McBuney point on the spinoumbilical line).

53
Ascending colon
  • Lies R lateral flank
  • Extent
  • Iliocaecal orifice to R colic flexure
  • 15 cm long
  • Peritoneum
  • Cover ant both sides, fixing it to post wall

54
Relations of ascending colon
  • Post
  • Lower pole R kidney
  • Iliohypogastric ilioinguinal nerves
  • Ant
  • Coils of small intestines
  • Parts of greater omentum

55
Transverse colon
  • 50 cm long
  • At umbilicus level largest most mobile
  • Extent
  • R - L colic flexures across the abd
  • L flexure more superior, acute angle less
    mobile than R flexure
  • Sup transverse mesocolon suspends it
  • Inf mesentery loops down to iliac crest,
    adherent to post wall of omental bursa

56
Transverse colon
57
Relations of the transverse colon
  • Post R-L
  • 2nd part duodenum, head of pancreas, small
    intestine, L kidney
  • Anterosuperiorly R-L
  • Liver, gb, stomach, greater omentum spleen
  • Transv colon mesentery
  • Attaches to body of pancreas
  • Continuous with parietal peritoneum

58
Descending colon
  • Narrowest part of colon L lateral flank
  • Extent Splenic flexure-LIF
  • 30 cm long
  • Peritoneum cover ant on both sides, fixing it
    to post wall
  • Flexure attached to diaphragm by phrenico-colic
    ligament, that also supports the spleen

59
Relations of descending colon
  • Post
  • Lower pole L kidney diaphragm
  • Quadratus lumborum, iliacus psoas
  • Peritoneal surfaces
  • In contact with coils of small intestines

60
Sigmoid colon
  • LIF, pelvic brim - S3 ant
  • 40 cm long, varies in position
  • Attached to pelvic wall by an inverted V-shaped
    sigmoid mesentery
  • Apex of V overlies L ureter, at bifurcation of
    common iliac v L sacroiliac joint
  • Taenia coli terminate 15 cm from anus, marking
    the recto-sigmoid junction

61
Relations of sigmoid colon
  • Post
  • Lies on L ureter common iliac vessels
  • Sup
  • Covered by coils of small intestine
  • Inf
  • Lies on urinary bladder in male
  • Lies on uterus in female

62
Rectum
  • 12 cm long, pelvic no mesentery
  • Extent
  • Rectosigmoid (S3) - anorectal j
  • Course from S3 curves forward, loops L as far as
    coccyx tip widens inf. into a rectal ampulla

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Relations of the rectum
  • Lat coils of small int covered by peritoneum
  • Inf levator ani, coccyx rectal vs
  • Post sup rectal art, S3, S4 S5, symp trunk,
    lat median sacral vs lower part of sacrum,
    coccyx
  • In both sexes, upper ? forms post wall of
    rectovesical pouch in ?, rectouterine in ?
  • In ? sem vesicles, d deferens, bladder
    prostate in ? post wall vagina uterus

65
Anal canal
  • 4 cm long
  • External internal sphincters
  • Internal
  • Involuntary (circular muscle coat)
  • Upper 2/3 canal, innervated by pelvic plexus
    sympathetic stimulation contracts muscle

66
Anal canal - cont
  • External - lower ? of canal
  • Superficial - surrounds lower part attaches to
    anococcygeal body perineal body inf. rectal n
  • Deep - mid part of canal, levator ani reinforces
    essential in function
  • Subcutaneous - thick ring of muscle surrounding
    anal orifice

67
Blood supply of large intestine
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Clinical correlates
  • Appendicitis
  • Cancer of large intestines

71
ACCESORY ORGANES
  • Spleen
  • The spleen is an ovoid organ varies considerably
    in size, weight, and shape however, it is
    usually approximately 12 cm long and 7 cm wide.
  • The spleen is located in the left upper abdominal
    quadrant or hypochondrium, where it receives the
    protection of the lower thoracic cage
  • The diaphragmatic surface of the spleen is
    convexly curved to fit the concavity of the
    diaphragm.

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  • The anterior and superior borders of the spleen
    are sharp and often notched, whereas its
    posterior (medial) end and inferior border are
    rounded.
  • It is relatively delicate and considered the most
    vulnerable abdominal organ.
  • As the largest of the lymphatic organs, it
    participates in the body's defense system as a
    site of lymphocyte (white blood cell)
    proliferation and of immune surveillance and
    response.

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  • The relations of the spleen are
  • Anteriorly, the stomach.
  • Posteriorly, the left part of the diaphragm,
  • Inferiorly, the left colic flexure.
  • Medially, the left kidney.
  • The spleen contacts the posterior wall of the
    stomach and is connected to its greater curvature
    by the gastrosplenic ligament and to the left
    kidney by the splenorenal ligament.

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  • These ligaments, containing splenic vessels, are
    attached to the hilum of the spleen on its medial
    aspect .
  • The splenic hilum is often in contact with the
    tail of the pancreas and constitutes the left
    boundary of the omental bursa.

75
Splenic vessels
  • The splenic artery is the largest branch of the
    celiac trunk Between the layers of the
    splenorenal ligament, the splenic artery divides
    into five or more branches that enter the hilum.
  • The splenic vein is formed by several tributaries
    that emerge from the hilum. With the IMV and SMV
    form the portal vein.

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  • The splenic lymphatic vessels leave the lymph
    nodes in the splenic hilum and pass along the
    splenic vessels to the pancreaticosplenic lymph
    nodes
  • The nerves of the spleen, derived from the celiac
    nerve plexus, are distributed mainly along
    branches of the splenic artery, and are vasomotor
    in function

77
Pancreas
  • The pancreas is an elongated, accessory digestive
    gland that lies retroperitoneally and
    transversely across the posterior abdominal wall,
    posterior to the stomach between the duodenum on
    the right and the spleen on the left.

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  • The pancreas produces
  • An exocrine secretion (pancreatic juice from the
    acinar cells) that enters the duodenum through
    the main and accessory pancreatic ducts.
  • Endocrine secretions (glucagon and insulin from
    the pancreatic islets of Langerhans) that enter
    the blood.

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  • The pancreas is divided into four parts head,
    neck, body, and tail.
  • The head of the pancreas is the expanded part of
    the gland that is embraced by the C-shaped curve
    of the duodenum to the right of the superior
    mesenteric vessels.

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Pancreatic ducts
  • The main pancreatic duct begins in the tail of
    the pancreas and runs through the parenchyma of
    the gland to the pancreatic head here it turns
    inferiorly and is closely related to the bile
    duct.
  • Most of the time, the main pancreatic duct and
    the bile duct unite to form the short, dilated
    hepatopancreatic ampulla (of Vater), which opens
    into the descending part of the duodenum at the
    summit of the major duodenal papilla.

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  • The sphincter of the pancreatic duct (around the
    terminal part of the pancreatic duct), the
    sphincter of the bile duct (around the
    termination of the bile duct), and the
    hepatopancreatic sphincter (of Oddi) around the
    hepatopancreatic ampulla are smooth muscle
    sphincters that control the flow of bile and
    pancreatic juice into the duodenum.

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BLOOD SUPPLY OF PANCREAS
  • The pancreatic arteries derive mainly from the
    branches of the markedly tortuous splenic artery,
    which form several arcades with pancreatic
    branches of the gastroduodenal and superior
    mesenteric arteries.
  • The corresponding pancreatic veins are
    tributaries of the splenic and superior
    mesenteric parts of the portal vein however,
    most of them empty into the splenic vein.

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  • The pancreatic lymphatic vessels follow the blood
    vessels.
  • Most vessels end in the pancreaticosplenic lymph
    nodes, that lie along the splenic artery. Some
    vessels end in the pyloric lymph nodes.
  • The nerves of the pancreas are derived from the
    vagus and abdominopelvic splanchnic nerves
    passing through the diaphragm.
  • The parasympathetic and sympathetic fibers reach
    the pancreas by passing along the arteries from
    the celiac plexus and superior mesenteric plexus

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LIVER
  • The liver is the largest gland. It weighs
    approximately 1500 g and accounts for
    approximately 2.5 of adult body weight.
  • It extends into the left hypochondrium, inferior
    to the diaphragm.
  • Except for fat, all nutrients absorbed from the
    gastrointestinal tract are initially conveyed
    first to the liver by the portal venous system.
  • In addition to its many metabolic activities, the
    liver stores glycogen and secretes bile.

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  • Bile passes from the liver via the biliary
    ductsright and left hepatic ducts that join to
    form the common hepatic duct, which unites with
    the cystic duct to form the bile duct.
  • The liver produces bile continuously however,
    between meals it accumulates and is stored in the
    gallbladder, which also concentrates the bile by
    absorbing water and salts. When food arrives in
    the duodenum, the gallbladder sends concentrated
    bile through the bile ducts to the duodenum.

88
Surfaces, Peritoneal Reflections, and
Relationships of the Liver
  • The liver has a convex diaphragmatic surface
    (anterior, superior, and some posterior) and a
    relatively flat or even concave visceral surface
    (posteroinferior),
  • Anatomical Lobes of the Liver
  • Externally, the liver is divided into two lobes
    and two accessory lobes by the reflections of
    peritoneum from its surface.
  • The essentially midline plane defined by the
    attachment of the falciform ligament and the left
    sagittal fissure separates a large right lobe
    from a much smaller left lobe

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Biliary Ducts and Gallbladder
  • The biliary ducts convey bile from the liver to
    the duodenum.
  • Bile is produced continuously by the liver and
    stored and concentrated in the gallbladder, which
    releases it intermittently when fat enters the
    duodenum. Bile emulsifies the fat, so that it can
    be absorbed in the distal intestine.

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  • Bile Duct
  • The bile duct (formerly, common bile duct) forms
    in the free edge of the lesser omentum by the
    union of the cystic duct and the common hepatic
    duct. The length of the bile duct varies from 5
    to 15 cm, depending on where the cystic duct
    joins the common hepatic duct.

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Gallbladder
  • The gallbladder (7-10 cm long) lies in the fossa
    for the gallbladder on the visceral surface of
    the liver.
  • The pear-shaped gallbladder can hold up to 50 mL
    of bile. Peritoneum completely surrounds the
    fundus of the gallbladder and binds its body and
    neck to the liver.
  • The hepatic surface of the gallbladder attaches
    to the liver by connective tissue of the fibrous
    capsule of the liver.

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  • The gallbladder has three parts
  • Fundus the wide end of the organ, projects from
    the inferior border of the liver and is usually
    located at the tip of the right 9th costal
    cartilage in the MCL.
  • Body contacts the visceral surface of the liver,
    the transverse colon, and the superior part of
    the duodenum.
  • Neck narrow and tapered directed toward the
    porta hepatis it makes an S-shaped bend and
    joins the cystic duct.

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  • The cystic duct (3-4 cm long) connects the neck
    of the gallbladder to the common hepatic duct.
  • The cystic duct passes between the layers of the
    lesser omentum, usually parallel to the common
    hepatic duct, which it joins to form the bile
    duct.

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Introductory Anatomy of Respiratory System
  • NYUNDO Martin, MD,MMed (General Surgeon)Lecturer
  • Dpt of Surgery and Dpt of Clinical Anatomy
  • FACMED-NUR

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General considerations
  • The respiratory system is made up of the organs
    involved in respiration
  • Respiration is the act of breathing
  • inhaling (inspiration) - taking in oxygen
  • exhaling (expiration) - giving off carbon dioxide
  • The respiratory system consists of the
  • Nose, pharynx, larynx, trachea, bronchi and lungs
  • lungs

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The pleura and airways
  • The respiratory tract is most often discussed in
    terms of upper and lower parts.
  • The upper respiratory tract relates to the
    nasopharynx and larynx whereas the lower relates
    to the trachea, bronchi and lungs.
  • Beginning at the larynx, the walls of the airway
    are supported by C-shaped rings of hyaline
    cartilage.
  • The sub-laryngeal airway constitutes the
    tracheobronchial tree.

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  • The thorax includes the primary organs of the
    respiratory and cardiovascular systems
  • The thorax is the superior part of the trunk
    between the neck and abdomen
  • Commonly the term chest is used as a synonym for
    thorax

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  • The thoracic cavity is divided into three major
    spaces
  • The central compartment, or mediastinum, houses
    the conducting structures that make up the
    thoracic viscera, except for the lungs
  • The lungs occupy the lateral compartments or
    pulmonary cavities that lie on each side of the
    mediastinum. Thus the majority of the thoracic
    cavity is occupied by the lungs,

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  • Parts of Respiratory system
  • Pharynx, Larynx
  • Trachea
  • Bronchi
  • Lungs

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The trachea
  • Located within the superior mediastinum,
    constitutes the trunk of the tree
  • It bifurcates at the level of the transverse
    thoracic plane (or sternal angle) into main
    (primary) bronchi, one to each lung, passing
    inferolaterally to enter the lungs at the hila
    (hilum)

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The trachea 2
  • Course
  • the trachea commences at the level of the cricoid
    cartilage in the neck (C6)
  • It terminates at the level of the angle of Louis
    (T4/5) where it bifurcates into right and left
    main bronchi
  • Structure
  • The trachea is a rigid fibroelastic structure
  • Incomplete rings of hyaline cartilage
    continuously maintain the patency of the lumen.
  • The trachea is lined internally with ciliated
    columnar epithelium.

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Trachea3
  • Relations
  • Behind the trachea lies the oesophagus
  • The 2nd, 3rd and 4th tracheal rings are crossed
    anteriorly by the thyroid isthmus
  • Blood supply
  • the inferior thyroid
  • bronchial arteries

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Bronchi
  • The right main bronchus is shorter, wider and
    takes a more vertical course than the left
  • The width and vertical course of the right main
    bronchus account for the tendency for inhaled
    foreign bodies to preferentially impact in the
    right middle and lower lobe bronchi.
  • The left main bronchus enters the hilum and
    divides into a superior and inferior lobar
    bronchus
  • The right main bronchus gives off the bronchus to
    the upper lobe prior to entering the hilum and
    once into the hilum divides into middle and
    inferior lobar bronchi.

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  • the air
  • enters the body through the nose or the mouth
  • travels down the throat through the larynx (voice
    box) and trachea (windpipe)
  • goes into the lungs through tubes called
    main-stem bronchi
  • one main-stem bronchus leads to the right lung
    and one to the left lung
  • in the lungs, the main-stem bronchi divide into
    smaller bronchi
  • and then into even smaller tubes called
    bronchioles
  • bronchioles end in tiny air sacs called alveoli

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The bronchi and bronchopulmonary segments
  • Each lobar bronchus divides within the lobe into
    segmental bronchi
  • Each segmental bronchus enters a
  • bronchopulmonary segment
  • Each bronchopulmonary segment is pyramidal in
    shape with its apex directed towards the hilum
  • It is a structural unit of a lobe that has its
    own segmental bronchus, artery and lymphatics.

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  • Beyond the direct branches of the lobar bronchi
    that is, beyond the segmental bronchi are from 20
    to 25 generations of branches that eventually end
    in terminal bronchioles
  • Each terminal bronchiole gives rise to several
    generations of respiratory bronchioles,
  • Each respiratory bronchiole provides 2-11
    alveolar ducts,
  • Each of which gives rise to 5-6 alveolar sacs
    lined by alveoli.

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  • The pulmonary alveolus is the basic structural
    unit of gas exchange in the lung.
  • New alveoli continue to develop until about age
    8 years, by which time there are approximately
    300 million alveoli.

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LUNGS
  • The lungs are a pair of cone-shaped organs made
    up of spongy, pinkish-gray tissue.

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Function
  • What do lungs do?
  • The lungs are the vital organs of respiration
  • Their main function is to oxygenate the blood by
    bringing inspired air into close relation with
    the venous blood in the pulmonary capillaries
  • The lungs take in oxygen, which all cells
    throughout the body need to live and carry out
    their normal functions
  • The lungs also get rid of carbon dioxide, a waste
    product of the body's cells.

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  • The lungs are separated from each other by the
    mediastinum, an area that contains the following
  • heart and its large vessels
  • trachea (windpipe)
  • esophagus
  • lymph nodes

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  • The lungs are inside in a membrane called the
    pleura.
  • The pleural cavitythe potential space between
    the layers of pleura contains a capillary layer
    of serous pleural fluid, which lubricates the
    pleural surfaces and allows the layers of pleura
    to slide smoothly over each other during
    respiration.
  • Its surface tension also provides the cohesion
    that keeps the lung surface in contact with the
    thoracic wall consequently, the lung expands and
    fills with air when the thorax expands while
    still allowing sliding to occur, much like a
    layer of water between two glass plates.

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  • Description of the lungs
  • Lobes marked by fissures
  • The right lung has three lobes
  • The left lung has two lobes.
  • Apex
  • Basis (diaphragmaic surf)
  • Border (ant, post and inf)
  • Surfaces ( costal, mediastinal and diaphragmatic)

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  • Relations of the lungs
  • Heart
  • Thoracic Aorta
  • Esophagus
  • Pulmonary artery
  • Pulmonary veins
  • Sup and inf vena cava

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CLINICAL CORRELATES
  • Infections bronchitis
  • Pneumothorax
  • Entry of air into the pleural cavity, resulting
    from a penetrating wound of the parietal pleura
  • Fractured ribs may also tear the visceral pleura
    and lung, thus producing pneumothorax.
  • Hydrothorax The accumulation of a significant
    amount of fluid in the pleural cavity may result
    from pleural effusion (escape of fluid into the
    pleural cavity).

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  • Hemothorax
  • With a chest wound, blood may also enter the
    pleural cavity.
  • Hemothorax results more commonly from injury to a
    major intercostal or internal thoracic vessel
    than from laceration of a lung.
  • Hemopneumothorax
  • If both air and fluid, (if the fluid is blood)
    accumulate in the pleural cavity, an air fluid
    level or interface (sharp line, horizontal
    regardless of the patient's position, indicating
    the upper surface of the fluid) will be seen on a
    radiograph.

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  • Thoracentesis
  • Sometimes it is necessary to insert a hypodermic
    needle through an intercostal space into the
    pleural cavity to obtain a sample of fluid or to
    remove blood or pus .
  • To avoid damage to the intercostal nerve and
    vessels, the needle is inserted superior to the
    rib, high enough to avoid the collateral
    branches.
  • Thoracic drainage chest tube

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  • LUNG CANCER
  • Lung cancer usually starts in the lining of the
    bronchi, but can also begin in other areas of the
    respiratory system, including the trachea,
    bronchioles, or alveoli.
  • Lung cancers are believed to develop over a
    period of many years
  • Nearly all lung cancers are carcinomas, a cancer
    that begins in the lining or covering tissues of
    an organ.
  • What are the risk factors for lung cancer?
  • A risk factor is anything that increases a
    person's chance of getting a disease such as
    cancer
  • Different cancers have different risk factors.
    Several risk factors make a person more likely to
    develop lung cancer
  • Smoking is the leading cause of lung cancer, with
    more than 90 percent of lung cancers thought to
    be a result of smoking.
  • Additional risk factors include
  • second-hand smoke - breathing in the smoke of
    others.
  • .

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Introductory Anatomy of Urinary System
  • NYUNDO Martin, MD, MMed (Surgeon)
  • Lecturer
  • Dpt of Surgery and Dpt of Clinical Anatomy
  • FACMED-NUR

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General considerations
  • The urinary system, with other organs regulates
    the volume and composition of the interstitial
    fluid.
  • The urinary system consists of the following
    organs
  • Two kidneys,
  • a single, midline urinary bladder,
  • two ureters, which carry urine from the kidneys
    to the urinary bladder
  • a single urethra, which carries urine from the
    bladder to the outside of the body

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KIDNEYS
  • The kidneys are the major excretory organs of the
    body they remove most waste products, many of
    which are toxic, from the blood and play a major
    role in controlling blood volume, the
    concetration of ions in the blood, the pH of the
    blood, red blood cell production and vitamin D
    metabolism.
  • The skin, liver, lungs and intestines eliminate
    some waste products, but if kidneys fail to
    function, other excretory organs cannot
    adequately compensate.

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KIDNEYS
  • The kidneys are bean shaped purplish-brown organs
    located below the ribs toward the middle of the
    back.
  • The lie on the posterior abdominal wall behind
    the peritoneum
  • The superior pole of each kidney is protected by
    the rib cage, and the right kidney is slightly
    lower than the left because of the presence of
    the liver superior to it.

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  • Each kidney measures about 11cm long, 5 cm wide
    and 3cm thick and weighs about 130g
  • On the medial side of each kidney is a small area
    called the hilium, where the renal artery and
    nerves enter and the renal vein and the ureter
    exit
  • The hilium opens into a cavity called the renal
    sinus which contains fat and connective tissue
  • The kidney is divided into an outer cortex and an
    inner medulla that surrounds the renal sinus

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  • The medulla cosists of a number of cone shaped,
    renal pyramids, which appear triangular when seen
    in a longitudinal section of the kidney
  • The base of each pyramid is located at the
    boundary between the cortex and the medulla, and
    the tips of the pyramids, the renal papillae are
    pointed toward the center of the kidney.

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  • Funnel shaped structures called minor calyces
    surround the renal papillae
  • The minor calyces from several pyramids join
    together to form larger funnels called major
    calyces
  • There are 8 to 20 minor calyces and 2 or 3 major
    calyces per kidney
  • This major calyces converge to form an anlarged
    channel called the renal pelvis, which is located
    in the renal sinus

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  • The renal pelvis then narrows to form a small
    tube, the ureter which exits the kidney and
    connects to the urinary bladder
  • Urine formed within the pyramids passes from the
    renal papillae into the minor calyces, from there
    urine moves into the the major calyces, collects
    in the renal pelvis and exits the kidney through
    the ureter.

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Nephron
  • The basic histological and functional unit of the
    kidney is the nephron, which consists of an
    enlarged terminal end called Bowmans capsule, a
    proximal convuluted tubule, a loop of Henle and
    distal convuluted tubule.
  • The distal convuluted tubule empties into a
    collecting duct, which carries the urine from the
    cortex of the kidney to the calyces.

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  • The Bowmans capsule and both convoluted tubules
    are in the renal cortex
  • The collecting tubules and parts of the loops of
    Henle enter the renal medulla.
  • There are about 1.300.000 nephrons in each kidney
    and one third of them must be functional to
    ensure survival.

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BLOOD SUPPLY
  • Renal artery from the abdominal aorta
  • Renal vein exits the kidney and connects to the
    inferior vena cava

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Ureters and urinary bladder
  • Ureters
  • narrow tubes that carry urine from the kidneys to
    the bladder.
  • The ureters extend inferiorly and medially from
    the renal pelvis at the renal hilium to reach the
    urinary bladder.
  • Muscles in the ureter walls continually tighten
    and relax forcing urine downward, away from the
    kidneys.
  • If urine backs up, or is allowed to stand still,
    a kidney infection can develop. About every 10 to
    15 seconds, small amounts of urine are emptied
    into the bladder from the ureters.

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  • The urinary bladder
  • is a hollow muscular container that lies in the
    pelvic cavity just posterior to the symphysis
    pubis.
  • In male it is just anterior to the rectum and in
    the female it is just anterior to the vagina znd
    inferior and anterior to the uterus.
  • The size of the bladder depens on the presence or
    absence of the urine.

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  • The ureters enter the bladder inferiorly on its
    posterolateral surface, and the urethra exits the
    bladder inferiorly and anteriorly
  • The traingular area of the bladder wall between
    the two ureters posteriorly and the urethra
    anteriorly is called trigone this region differs
    histologically from the rest of the bladder wall
    and does not expand during bladder filling

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  • At the junction of the urethra with the bladder,
    smooth muscle of the bladder forms the internal
    urinary sphincter
  • The external urinary sphincter is skeletal muscle
    that surrounds the the urethra as the urethra
    extends through the pelvic floor
  • The sphincters control the flow of urine through
    the urethra.

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  • In the male the urethra extends to the end of the
    penis, where it opens to the outside
  • The female urethra is much shorter than the male
    urethra and opens into the vestibule anterior to
    the vaginal opening

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Facts about urine
  • Adults pass about a quart and a half of urine
    each day, depending on the fluids and foods
    consumed.
  • The volume of urine formed at night is about half
    that formed in the daytime.
  • Normal urine is sterile. It contains fluids,
    salts and waste products, but it is free of
    bacteria, viruses and fungi.
  • The tissues of the bladder are isolated from
    urine and toxic substances by a coating that
    discourages bacteria from attaching and growing
    on the bladder wall

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Introductory Anatomy of Reproductive System
  • NYUNDO Martin, MD, MMed (Surgeon)
  • Lecturer
  • Dpt of Surgery and Dpt of Clinical Anatomy
  • FACMED-NUR

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  • Animals reproductive systems can be divided into
    the internal reproductive organs and the external
    genitalia. The gonads are the actual organs that
    produce the gametes. In the male, testes
    (singular testis) produce sperm cells, and in
    the female, ovaries make ovules (eggs).

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Male Reproductive System
  • Testis
  • . Sperm cells are produced in the testes located
    in the scrotum. Normal body temperature is too
    hot thus is lethal to sperm so the testes are
    outside of the abdominal cavity where the
    temperature is about 2 C (3.6 F) lower..
  • Epididymis
  • From there, sperm are transferred to the, coiled
    tubules also found within the scrotum, that store
    sperm and are the site of their final maturation.

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  • Vas deferens (plural vasa deferentia)
  • In ejaculation, sperm are forced up int the vas
    deferens From the epididymis, the vas deferens
    goes up, around the front of, over the top of,
    and behind the bladder.
  • The ends of the vasa deferentia, behind and
    slightly under the bladder, are called the
    ejaculatory ducts.

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  • The seminal vesicles are also located behind the
    bladder. Their secretions are about 60 of the
    total volume of the semen ( sperm and associated
    fluid) and contain mucus, amino acids, fructose
    as the main energy source for the sperm, and
    prostaglandins to stimulate female uterine
    contractions to move the semen up into the
    uterus.
  • The seminal vesicles empty into the ejaculatory
    ducts. The ejaculatory ducts then empty into the
    urethra (which, in males, also empties the
    urinary bladder).

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  • PROSTATE
  • The initial segment of the urethra is surrounded
    by the prostate gland (note spelling!). The
    prostate is the largest of the accessory glands
    and puts its secretions directly into the
    urethra. These secretions are alkaline to buffer
    any residual urine, which tends to be acidic, and
    the acidity of the womans vagina.
  • The prostate needs a lot of zinc to function
    properly, and insufficient dietary zinc (as well
    as other causes) can lead to enlargement which
    potentially can constrict the urethra to the
    point of interferring with urination.

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  • The bulbourethral glands or Cowpers glands are
    the third of the accessory structures. These are
    a small pair of glands along the urethra below
    the prostate. Their fluid is secreted just before
    emission of the semen, thus it is thought that
    this fluid may serve as a lubricant for inserting
    the penis into the vagina, but because the volume
    of these secretions is very small, people are not
    totally sure of this function.

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  • Penis
  • The urethra goes through the penis.
  • In humans, the penis contains three cylinders of
    spongy, erectile tissue (corpus cavemosum and
    corpus spongiosum) . During arousal, these become
    filled with blood from the arteries that supply
    them and the pressure seals off the veins that
    drain these areas causing an erection, which is
    necessary for insertion of the penis into the
    womans vagina.
  • The head of the penis, the glans penis, is very
    sensitive to stimulation.
  • In humans, as in other mammals, the glans is
    covered by the foreskin or prepuce, which may
    have been removed by circumcision.

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Female Reproductive System
  • Ovary
  • ovules are produced in the ovaries,
  • Each ovule is released into the abdominal cavity
    near the opening of one of the oviducts or
    Fallopian tubes.

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Uterus
  • The uterus is a hollow, thick-walled, pear-shaped
    muscular organ in the female reproductive system.
  • During pregnancy the uterus expands to
    accommodate a developing embryo.
  • It is located between the urinary bladder in
    front and the rectum behind, and sits above the
    vagina.
  • The lower narrow portion of the uterus is called
    the cervix and it protrudes downward into the
    opening of the vaginal canal.
  • The vaginal canal extends downward to the
    external female genitalia.

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  • The uterine tubes, or Fallopian tubes, extend
    from either side of the uterus and act as a
    channel for eggs from the ovary to travel to the
    uterus. When an egg is fertilized (joined with
    sperm), it becomes embedded in the wall of the
    uterus (whose lining becomes thickened) where the
    fertilized egg grows into an embryo and later a
    fetus.
  • If an egg is not fertilized, the thickened
    uterine lining sloughs off in a process known as
    menstruation.

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  • The uterus has thick, muscular walls and is very
    small.
  • In a nulliparous woman, the uterus is only about
    7 cm long by 4 to 5 cm wide, but it can expand to
    hold a 4 kg baby.
  • The lining of the uterus is called the
    endometrium, and has a rich capillary supply to
    bring food to any embryo that might implant there.

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Vagina
  • The vagina
  • is a relatively-thin-walled chamber
  • It servs as a repository for sperm (it is where
    the penis is inserted), and also serves as the
    birth canal. Note that, unlike the male, the
    female has separate opening for the urinary tract
    and reproductive system.
  • These openings are covered externally by two sets
    of skin folds. The thinner, inner folds are the
    labia minora and the thicker, outer ones are the
    labia majora.
  • The labia minora contain erectile tissue like
    that in the penis, thus change shape when the
    woman is sexually aroused.

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  • The opening around the genital area is called the
    vestibule.
  • There is a membrane called the hymen that
    partially covers the opening of the vagina. This
    is torn by the womans first sexual intercourse
    (or sometimes other causes like injury or some
    kinds of vigorous physical activity).
  • In women, the openings of the vagina and urethra
    are susceptible to bacterial infections if fecal
    bacteria are wiped towards them. Thus, while
    parents who are toilet-training a toddler usually
    wipe her from back to front, thus imprinting
    that sensation as feeling right to her, it is
    important, rather, that that little girls be
    taught to wipe themselves from the front to the
    back to help prevent vaginal and bladder
    infections. Older girls and women who were taught
    the wrong way need to make a conscious effort to
    change their habits.

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  • At the anterior end of the labia, under the pubic
    bone, is the clitoris, the female equivalent of
    the penis. This small structure contains erectile
    tissue and many nerve endings in a sensitive
    glans within a prepuce which totally encloses the
    glans.
  • This is the most sensitive point for female
    sexual stimulation, so senstiive that vigorous,
    direct stimulation does not feel good.

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